Intracardiac pseudotumor caused by mitral annular calcification

Vrey, Evelyn A. de; Scholte, Arthur J.; Krauss, X. H.; Dion, Robert; Poldermans, Don; Wall, E. E. van der; Bax, Jeroen J.

doi:10.1016/j.euje.2005.02.004

Cited by 26 publications

(27 citation statements)

References 13 publications

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“…Typical presentation will be in the shape of a large, round, echodense, inconsistent mass with a liquid central region, which can be confused with an intracardiac tumor [4]. Typical location is at the posterior part of the mitral annulus [5]. Among the complications described, hemodynamic (mitral insufficiency and syncope) and embolic (stroke) events can be noted.…”

Section: Discussionmentioning

confidence: 96%

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Spontaneous fistulization of a caseous calcification of the mitral annulus: an exceptional cause of stroke

Chevalier¹,

Réant²,

Laffite³

et al. 2011

European Journal of Cardio-Thoracic Surgery

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We present the case of a caseous calcification of the mitral annulus, responsible for two strokes, in a 72-year-old female patient. The brain computed tomography (CT) scan confirmed the presence of a calcific embolus. The echocardiography showed a liquidy, pseudotumoral mass combined with numerous calcifications located in the posterior part of the mitral annulus and extending toward the inferior surface of the left ventricle. During surgery, we found a direct communication between the caseous necrosis and the lumen of the left ventricle at the level of its inferior wall. We performed a valve repair procedure and excision of the caseous necrosis, combined with injection of bioglue into the cavity, to avoid recurrence. Six months after the procedure, the patient was in good health, and had no recurrence of stroke with a satisfactory echocardiography. This is the first description of spontaneous fistulization of a caseous necrosis in the lumen of the left ventricle, explaining a new mechanism for cerebral embolism during the course of calcifying diseases of the mitral annulus.

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Section: Discussionmentioning

confidence: 96%

“…However, opinion is divided as to the type of surgical treatment suitable. Excision of the caseous zone seems to be admitted by all, and the techniques of repair [5] or of valve replacement [1] are preferred, depending on local conditions. The pathophysiological mechanism underlying emboli is still the subject of debate.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous fistulization of a caseous calcification of the mitral annulus: an exceptional cause of stroke

Chevalier¹,

Réant²,

Laffite³

et al. 2011

European Journal of Cardio-Thoracic Surgery

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“…Although the clinical course of mitral annular calcification is benign, it can be complicated by secondary infections, arrhythmias, mitral valvular regurgitation, stenosis or thromboembolism [6,7]. Moreover it can mimick tumors, vegetations or thrombi.…”

Section: Discussionmentioning

confidence: 99%

A case of mobile mitral annular mass

Elalmış¹,

Karagöz²,

Şahin³

et al. 2013

CMJ

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Mitral annular calcification is a chronic, degenerative process of the mitral valve fibrous ring, primarily involving the posterior annulus. This report presented a case of mitral annular calcification with mobile components which was found incidentally during TTE. The echocardiographic differential diagnosis of a mass includes thrombus, vegetation, primary or secondary cardiac tumor and extensive mitral annular calcification with mobile components. A calcified, mobile mass attached to the posterior mitral annulus should raise the suspicion of extensive mitral annular calcification. Serial echocardiograms in our patient documented that these mobile elements can resolve rapidly. The optimal treatment or clinical approach to this clinical condition remains to be established.

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“…10 The mechanism of stroke is thought to be embolic, and thrombus overlying MAC has been described, 10 but calcific embolism has also been suggested. 1 We presume thromboembolism was the mechanism of the transient ischaemic attack. The rapid resolution of symptoms and the freedom from further embolism while anticoagulated provide circumstantial support for this hypothesis.…”

Section: Discussionmentioning

confidence: 99%

Multimodality imaging of exuberant mitral annular calcification in a patient presenting with transient ischaemic attack

Vijayan

Fielding²,

Kahan³

et al. 2011

J R Coll Physicians Edinb

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An 81-year-old woman presented to the emergency department with sudden onset weakness of the right side of the body, which had caused her to fall through a glass door and injure her arm. She also had expressive dysphasia. The patient had a previous medical history of hypertension, hypercholesterolaemia and spondylosis. More than a decade ago she had been labelled as suffering from 'angina', based on asymptomatic ST-segment depression during stage 2 of a Bruce protocol. There was no history of rheumatic fever.Her weakness and expressive dysphasia resolved completely in 90 minutes. On examination, the arterial pulse was regular and normal in character, blood pressure was 138/72 mmHg in the right arm and the heart rate was 80 bpm. The patient's electrocardiogram showed sinus rhythm with occasional ventricular ectopic beats. The first heart sound was loud and there was a pansystolic murmur grade 3/6 at the mitral area. Neurological examination performed by the admitting physician was normal. Figure 1 Zoomed, slightly off-axis apical four-chamber view, demonstrating a globular mass with a hypoechoic centre, in the lateral segment of the mitral annulus. Figure 2Transoesophageal echocardiographic appearances of the mass, in a four-chamber view. The relationship with the mitral valve is better appreciated than on the transthoracic scan. The mass is located on the ventricular aspect of the annulus and distorts the posterior mitral leaflet slightly.

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Intracardiac pseudotumor caused by mitral annular calcification

Cited by 26 publications

References 13 publications

Spontaneous fistulization of a caseous calcification of the mitral annulus: an exceptional cause of stroke

Spontaneous fistulization of a caseous calcification of the mitral annulus: an exceptional cause of stroke

A case of mobile mitral annular mass

Multimodality imaging of exuberant mitral annular calcification in a patient presenting with transient ischaemic attack

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